Dinaz Fitness

Health & Lifestyle
Assessment

A considered picture of your health, habits and ambitions, so your programme can be built precisely around your life. It takes around ten minutes. Only your name and email are required — answer the rest as fully as you are comfortable. Your responses are shared with Dinaz alone, and are held in strict confidence.

Personal Details

So we know who we are working with, and how best to reach you.

Full name*

Email address*

Phone number

Age

Gender

Height

Weight

Occupation

City of residence

Health History

Medical background that shapes how your programme is designed.

Existing medical conditions

Past surgeries or injuries

Current medications and supplements

Allergies or intolerances

Relevant family history

Most recent bloodwork

Any pain, stiffness or mobility limitations

Nutrition

A candid picture of how you currently eat and drink.

A typical day of eating

Usual meal timings

Dietary preference

Daily water intake

Alcohol

Tea / coffee per day

Eating out or ordering in

Cravings and trigger foods

Digestion — bloating, acidity, regularity

Fitness & Activity

Your movement history, present routine and what is available to you.

Current exercise routine

Past training experience

Daily movement outside exercise

Injuries that affect how you train

Forms of movement you enjoy

Access to a gym, trainer or home equipment

Sleep & Recovery

Recovery quality is often the deciding factor in results.

Usual bedtime

Usual waking time

Average hours of sleep

Sleep quality

Waking during the night

Sleep aids or medication used

Energy through the day

Stress & Mental Wellbeing

Understanding your load helps us set a realistic pace.

Current stress level

Daily screen time

Main sources of stress

How you typically unwind

Meditation, breathwork or therapy

Work travel

Lifestyle

The realities of your day that any plan must fit around.

Smoking or tobacco

Work pattern

Social and food commitments in a usual month

Support at home — family, cook, household help

Who plans and prepares your meals

Goals & Commitment

What success looks like to you, and the time you can give it.

Primary goals

Timeline you have in mind

Days and hours available each week

What you have tried before

Your biggest obstacles

Anything else Dinaz should know

Your answers are saved on this device as you type.